The present invention relates to a method for enabling medical care providers, particularly, mental health practitioners and providers, to evaluate and review the condition of a patient and a proposed course of treatment for that patient.
The quality of medical care is determined in large part by the quality of the decisions that determine what actions are taken. Psychiatry, like medicine in general, has done little to reduce the variance in clinical decision making. Consider the admission data for psychiatric illness as displayed in FIG. 1. As shown therein, admission rates for psychiatric care may vary on the order of 16 to 1. Even between Health Maintenance Organizations (HMO's), the variation rate may exceed 8 to 1. Inasmuch as variances in admission rates reflect normative judgements concerning medical necessity, it can be seen that there is considerable variability in actual clinical practice. The fact is that psychiatrists like other physicians frequently make decisions based upon extra-clinical considerations. These include financial incentives, pressure from the patient or his/her family, specialist enthusiasm, the convenience of the doctor and/or the patient, the failure of non-medical providers to appropriately interface with psychiatrists or vice-versa, cultural imperatives to "do something", and malpractice concerns among others. In sum, one can say that hospital-based utilization is, to a significant extent, due to the practice patterns of local psychiatrists as well as the range and availability of the treatment resources in a community's system of care and not to the epidemiological incidence of psychiatric disease.
These findings raise concerns about the high incidence of false positives, that is, overtreatment in the form of overutilization of hospital based treatment. Also, of concern, is the recent tendency to withhold hospitalization treatment as a result of a system which frequently rewards providers for withholding care or for providing less intensive and costly care than is necessary.
There clearly is a need for a product to assist mental health professionals in precertification decisions.